Consultations

The Australian Digital Health Agency (the Agency) has recently released the National Digital Health Strategy Consultation. The findings from this consultation will be used by the Agency to identify new ways to deliver more effective and efficient health and care, and guide the development of a national digital health strategy for delivery to Government in 2017.

Use of secure electronic communications

Patients are required to interact with multiple healthcare professionals or organisations in different physical locations. In order to provide high quality, effective and safe healthcare, there has to be efficient communication between general practitioners and other healthcare providers involved in a patient’s care. Secure electronic communication is currently one of the most efficient methods of communication.

The RACGP would like to see the elimination of paper forms in general practice within three years. There are however a range of concerns that members may have with the increased use of electronic forms. In September 2016, the RACGP released a position statement: The use of secure electronic communication within the health care system. This outlines support for the following principles for electronic communication between general practice and other healthcare agencies:

all electronic communications templates and systems should use existing data and information from general practice clinical information systems to pre-populate documents and forms

all communications should be

created and sent from within the general practice’s electronic clinical software system and

automatically received into the local patient electronic health record via the clinical software system inbox

all electronic communications to external healthcare providers and agencies should be sent securely using secure messaging to align with best practice data privacy handling principles to protect patient privacy and confidentiality.

We are seeking your feedback on what challenges you face in increased use of two-way secure electronic communication; completing forms for corporate and government agencies, as well as your reasons for using electronic forms. Below is a brief survey seeking your input.

Redesigning the Practice Incentives Program

In the 2016-17 Federal Budget, the Australian Government announced a review of the Practice Incentives Program (PIP). The Department of Health has released a consultation paper on Redesigning the Practice Incentives Program and is seeking stakeholder feedback on the redesign.

The stated intention of the redesign is to reduce the administrative burden associated with multiple PIP payments and move towards a streamlined and simplified system. The redesign will introduce a Quality Improvement Incentive to replace 7 of the 11 incentives in the current PIP. It is anticipated that funds available through the redesigned PIP will remain unchanged from current levels. The After-hours, eHealth, Rural Loading and Teaching incentives will not be affected by the PIP redesign.

The RACGP is seeking your feedback on a number of key questions raised in the consultation paper. In addition to the questions raised in the paper, the RACGP is also seeking your feedback on the two preliminary redesign options outlined on page 15 – 16 of the consultation paper.

The RACGP consultation period closes on Wednesday 9 November 2016.

The Consultation paper raises the following key questions:

What are the strengths of the current PIP? How has the PIP influenced your quality improvement work to date? What elements of the current PIP should be kept and which should change? What aspects of the current PIP can be improved through better use of technology? What is the best way to ensure the PIP funds meet the principle for efficient, effective and economical and ethical use of public money? How would we ensure that the needs of Aboriginal and Torres Strait Islander people are considered and continue to be met under a redesigned PIP? Would you participate in a patient focussed quality improvement PIP incentive? What are the key aspects of quality improvement that should be captured in a redesign of the PIP? Would you like to provide an example of a quality Practice improvement incentive payment as outlined? Do you support the use of collated regional data for population health and planning purposes? Do you have any suggestions to improve the proposed Quality Improvement Incentive payment?

30 October 2016

5th edition Standards: Patient Feedback Guide

The RACGP is currently developing the 5th edition of the Standards for general practices (the Standards), to be released in October 2017.

Feedback from stakeholders and practices on patient feedback in 4th edition Standards indicates that the requirements are too prescriptive and focus on the process for collecting the feedback rather than the outcome.

As a result of the feedback received and the move to more outcomes focused Indicators in the 5th edition Standards, the requirements relating to patient feedback have been modified to provide increased flexibility for practices in how they undertake patient feedback.

► A. Our practice seeks feedback from patients, carers and other relevant parties in accordance with the RACGP Patient Feedback Guide: learning from our patients (the Patient Feedback Guide). ► B. Our practice can demonstrate how we have analysed and responded to feedback and considered feedback for quality improvement ► C. Our practice promotes how we have responded to feedback and used feedback for quality improvements.

The above Indicators focus on the importance of:

collecting the feedback

analysing the feedback

using the feedback for quality improvement purposes.

In order to reflect the requirements of the Indicators in the 5th edition Standards, the Patient Feedback Guide has been revised and updated.

The RACGP will consider all feedback received to inform the next draft of the Patient Feedback Guide. The Patient Feedback Guide will be released with the 5th edition Standards in October 2017. For more information on the development of the 5th edition Standards visit the Standards development page.

31 October 2016

Responding to financial pressures with newbusiness models and billing practices

As highlighted in September’s Good Practice, GPs and their practices are looking at their financial bottom line to determine how they can remain viable in response to the Medicare freeze. Many practices are adapting to the landscape by shifting billing models, and introducing copayments and other fees so that they can combat financial pressures and continue to provide quality general practice services to their patients.

The RACGP is looking to prepare case studies of GPs and practices adapting to inform members of what their peers are doing. We invited members to answer our poll below and provide information regarding any models or approaches their practice has implemented (successful or otherwise).

Respondents were asked to comment on:

the triggers that made you contemplate change

the obstacles you faced, and whether/how these were overcome

patient reactions to change

how you assessed success

what made your plan effective, or otherwise.

7 October 2016

Putting prevention into practice: guidelines for the implementation of prevention in the general practice setting (the Green book).

The RACGP is developing a new edition of the Green book. The Green book is the companion to the RACGP Guidelines for preventive activities in general practice (the Red book), and is designed to be a practice resource to strengthen prevention activities in general practice.

The guide is intended to improve professional relationships between GPs and other medical specialists. While it provides advice on referrals by GPs to specialists, it does not address how other medical specialists manage GP referrals.

Some of the issues currently being considered by the RACGP and identified in recent commentary include other medical specialists:

asking for a new referral for a patient with the same ongoing problem every 12 months

at times not acknowledging or responding to referrals from GPs

at times not accepting indefinite or timed referrals from GPs other than 12 months

inconsistently communicating with the referring GP about any referrals to other specialists.

In this consultation, the RACGP sought member feedback on these issues and any additional experiences relating to how other medical specialists’ have handled your referrals. Feedback will inform our advocacy on behalf of GPs on these issues.

In April 2015, the Department of Health announced the formation of the Medicare Benefits Schedule (MBS) Review Taskforce as part of the Government’s Healthier Medicare initiative. The Taskforce is reviewing the MBS in its entirety, considering individual items as well as the rules and legislation governing their application. The first review from the MBS Review Taskforce was released at the end of 2015, with 23 items removed from the MBS. An Interim Report to the Minister for Health was released on 6 September 2016. The MBS Review Taskforce’s Clinical Committees released six Clinical Committee reports and the First Report of the MBS Principles and Rules Committee for public consultation. The reports released for public consultation include:

First report of the MBS Principles and Rules Committee

Report from the Gastroenterology Clinical Committee

Report from the Obstetrics Clinical Committee

First report from the Diagnostic Imaging Clinical Committee – Low Back Pain

First report of the Ear, Nose and Throat Surgery Clinical Committee on Tonsillectomy, Adenoidectomy & Insertion of Grommets

The MBS Review Taskforce called on health professionals to have their say about the recommendations proposed by the Clinical Committees, prior to consideration by the MBS Taskforce and subsequent recommendations being made to Government.

In order to inform the RACGP’s Submission to the MBS Review Taskforce on each of these reports, we called on member feedback on the recommendations made within each.

27 May 2016

Extension of freeze on MBS patient rebates - tell us how it will affect you and your practice

On 3 May 2016, as part of its 2016–17 Federal Budget, the federal government announced an extension of the freeze on the Medicare Benefits Schedule (MBS) for a further two years until 30 June 2020.

The extension of the MBS freeze will have significant implications on the affordability of vital health services and the overall sustainability of general practice. There is now an even greater likelihood of reduced access for patients and higher out of pocket costs, as GPs strive to maintain viable practices.

In 2015, the RACGP surveyed members on how the freeze was affecting patient services, with the majority of respondents saying they would be forced to pass increased out-of-pocket expenses onto patients.

The continued freeze and its extension until 2020 demonstrates the federal government’s sustained efforts to ignore and devalue GPs and the crucial services provided by general practices.

The RACGP will increase advocacy efforts to have the indexation freeze lifted. To assist us with our efforts, we asked to hear your stories and examples of how the freeze is impacting you, your patients and your community and how you and your practice will adapt.

The RACGP thanks all respondents for their feedback. We will use this information in continued advocacy efforts for appropriate indexation of Medicare rebates.

The RACGP’s You’ve been targeted campaign includes further information for both GPs and patients on how the freeze will affect them, including fact sheets, posters and letters to send to local candidates.

the prevalence of bullying and harassment in Australia’s medical profession;

any barriers, whether real or perceived, to medical practitioners reporting bullying and harassment;

the roles of the Medical Board of Australia, the Australian Health Practitioners Regulation Agency and other relevant organisations in managing investigations into the professional conduct (including allegations of bullying and harassment), performance or health of a registered medical practitioner or student;

the operation of the Health Practitioners Regulation National Law Act 2009 (the National Law), particularly as it relates to the complaints handling process;

whether the National Registration and Accreditation Scheme, established under the National Law, results in better health outcomes for patients, and supports a world-class standard of medical care in Australia;

the benefits of ‘benchmarking’ complaints about complication rates of particular medical practitioners against complication rates for the same procedure against other similarly qualified and experienced medical practitioners when assessing complaints;

the desirability of requiring complainants to sign a declaration that their complaint is being made in good faith; and

any related matters.

The RACGP is seeking your feedback regarding the medical complaints handling process in Australia, including any further information you feel is relevant to this inquiry.

New MBS Proposal – Fibroscan for the diagnosis of liver fibrosis in patients with hepatitis B or C

The Medical Services Advisory Committee (MSAC) are considering an application for a new MBS item using Transient Elastography (TE, known by its trade name, Fibroscan) for the diagnosis of liver fibrosis in patients with chronic hepatitis B or hepatitis C.

The RACGP are seeking member views and feedback to assist us in developing a response. Specifically, MSAC are seeking feedback on:

The clinical utility of Fibroscan for patients with hepatitis C or hepatitis B

The diagnostic information offered by Fibroscan compared to the information provided through other currently available tests. For example, what benefits does Fibroscan offer over other existing diagnostic services? Does the use of Fibroscan change treatment options/regimes for patients?

Dissemination of the service into gastroenterology and GP practices. Is this service currently offered? And if so, in what type of practices? Would an MBS rebate affect uptake for this service?

Development of the 5th edition Standards for general practices

The Royal Australian College of General Practitioners (RACGP) develops the RACGP Standards for general practices (the Standards). The Standards are designed as a template for quality care and risk management in Australian general practice as well as a framework for good practice in the ongoing operation of a general practice.

The RACGP has now concluded its Second Consultation Phase for the 5th edition Standards for general practices . In this Phase, the RACGP sought the views of stakeholders regarding the first draft of the Standards.

It is important to note that this first draft of the 5th edition Standards is a working draft. There will be further revisions to successive drafts of the Standards based on feedback received which will be released for stakeholder feedback prior to the release of the 5th edition Standards in October 2017.

Emerging after-hours services in Australia

The number of Medical Deputising Services (MDS) and dedicated after-hours services operating across Australia have increased significantly in recent years. It appears that the increase in the number of MDS and after-hours services has been driven by a number of factors:

difficulties in attracting GPs to work unsociable hours and difficulties in securing appropriate support and financial incentives

other factors impacting the sustainability and viability of general practice (rebate freeze, inadequate support).

General practice has a long history of working with after-hours services. However, there have recently been concerns raised by RACGP Members regarding some after-hours services currently operating across Australia.

To date, particular concerns raised by RACGP Members include:

fragmentation of care when there is no link to an established GP or practice

the lack of infrastructure within some of these services which does not support the provision of quality care

the aggressive approach to advertising that some services undertake, highlighting an entrepreneurial type of business model (making these services more appealing to patients)

the increase in the use of after-hours patient rebates, and urgent after-hours items.

The RACGP Expert Committee – General Practice Advocacy and Funding (REC-GPAF) is currently considering the impacts of after-hours services on the provision of quality primary healthcare after-hours services in Australia.

To progress this work the REC-GPAF is seeking feedback regarding these types of services from the broader RACGP Membership.

All comments and feedback received will be used to ensure the RACGP is best placed to represent the views of the profession in its future advocacy work.

The RACGP is seeking feedback on Cancer Council Australia’s Draft clinical management guidelines for the prevention of cervical cancer . These guidelines will supersede the NHMRC approved 2005 Guidelines Screening to prevent cervical cancer: guidelines for the management of asymptomatic women with screen-detected abnormalities .

With the change to primary HPV testing it was necessary and timely to review the 2005 Guidelines and to consider recent evidence to formulate guidelines that are relevant to primary HPV testing and triage using liquid-based cytology. The guidelines aim to assist women and health professionals to achieve best outcomes in clinical management of women with screen-detected cervical abnormalities.

The Guidelines were commissioned by the Department of Health to support the renewed National Cervical Screening Program coming into effect on 1 May 2017. Larissa Roeske is on the Guidelines committee and Amanda McBride is the RACGP Rep on the steering committee for the National Cervical Screening Program.

The RACGP has sought feedback on the Committee’s terms of reference (below) and the challenges for GPs of working in residential aged care facilities or in aged care more generally.

Inquiry into the future of Australia’s aged care sector workforce

Terms of reference:

the current composition of the aged care workforce;

future aged care workforce requirements, including the impacts of sector growth, changes in how care is delivered, and increasing competition for workers;

the interaction of aged care workforce needs with employment by the broader community services sector, including workforce needs in disability, health and other areas, and increased employment as the National Disability Insurance Scheme rolls out;

challenges in attracting and retaining aged care workers;

factors impacting aged care workers, including remuneration, working environment, staffing ratios, education and training, skills development and career paths;

the role and regulation of registered training organisations, including work placements, and the quality and consistency of qualifications awarded;

government policies at the state, territory and Commonwealth level which have a significant impact on the aged care workforce;

relevant parallels or strategies in an international context;

the role of government in providing a coordinated strategic approach for the sector;

challenges of creating a culturally competent and inclusive aged care workforce to cater for the different care needs of Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse groups and lesbian, gay, bisexual, transgender and intersex people;

The RACGP provided comment on the first round of recommendations from MBS Review Taskforce Clinical Committees on items that they considered obsolete and should be removed from the MBS. The RACGP broadly supported the Clinical Committee recommendations and welcomed the inclusion of GPs on the committees. However, the RACGP is concerned that savings found from removing items from the MBS will not be reinvested into healthcare.